Integrating tuberculosis treatment into community pharmacies to improve TB/HIV outcomes in Uganda. - PROJECT SUMMARY/ABSTRACT
The overall objective of this K43 Emerging Global Leader Award is to support Dr. Jonathan Izudi’s transition to
independence as an implementation scientist focused on improving tuberculosis (TB)/HIV care. Dr. Izudi's long-
term goal is to reduce the TB burden among people living with HIV (PLHIV) by tackling barriers to successful
prevention, diagnosis, and treatment using context-relevant interventions delivered through person-centered
strategies. The overall objective of this K43 grant application is to develop and pilot an implementation strategy
focused on integrating TB treatment into community pharmacies among people with TB/HIV in Uganda. People
with TB/HIV have sub-optimal treatment outcomes, with the pooled treatment success rate averaging 70-71%,
far below the World Health Organization's desired target of ≥90%. Compared to people who do not have HIV,
treatment success is 35-47% lower and the risk of developing multi-drug resistant TB is 24% higher. Community
pharmacies are a proven differentiated antiretroviral therapy (ART) service delivery model that has been
successful in moving ART from central health facilities to the community. In doing so, ART access, coverage,
and adherence are improved because medication pick-ups are more convenient, inadvertent HIV status
disclosure and community stigma are prevented, and health workers can focus on people with adherence
challenges. Community pharmacies present a potential to provide similar benefits to people with TB/HIV through
offering TB medication refills. Dr. Izudi hypothesizes that a theory-informed, context-relevant strategy for
integrating TB treatment into community pharmacies adapted to the needs of people with TB/HIV and health
workers will improve TB treatment success. To test the central hypothesis, Dr. Izudi proposed three specific
aims: Aim 1) to explore the barriers and facilitators to integrating TB treatment into community pharmacies
among people with TB/HIV; Aim 2) to adapt a person-centered strategy for integrating TB treatment into
community pharmacies using human-centered design methodology; and, Aim 3) to evaluate the implementation
outcomes (feasibility, fidelity, and acceptability) and preliminary effectiveness of integrating TB treatment into
community pharmacies among people with TB/HIV. Completion of the aims will provide the preliminary data to
support Dr. Izudi's application for an R01 proposing a cluster-randomized trial to evaluate the implementation
and effectiveness of integrating TB treatment into community pharmacies at the national level. In addition,
conducting the proposed studies will enable Dr. Izudi to achieve four training goals: 1) To acquire advanced skills
in qualitative and mixed methods research; 2) To gain skills and competence in implementation science research
enabling the sound use of theories, models, and frameworks; 3) To gain expertise in interventional studies in
implementation science research; and 4) To gain expertise in grantsmanship for transition to a successful
research career. The proposed studies will enable Dr. Izudi to complement his skillset in public health and
epidemiology with advanced skills in socio-behavioral research, implementation science, and interventional
studies through specific training and tailored mentorship.
